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首页> 外文期刊>The American Journal of Cardiology >Meta-Analysis of Complete versus Culprit-Only Revascularization in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Disease
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Meta-Analysis of Complete versus Culprit-Only Revascularization in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Disease

机译：在ST段抬高心肌梗死患者患者中完全分析的完全与罪魁祸首血运重建，患者

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Approximately half of patients with ST-segment elevation myocardial infarction (STEMI) present with noninfarct related multivessel coronary artery disease (CAD) during primary percutaneous coronary intervention (PCI). However, questions remain concerning whether patients with STEMI and multivessel CAD should routinely undergo complete revascularization. Our objective was to compare the risks of major cardiovascular outcomes and procedural complications in patients with STEMI and multivessel CAD randomized to complete revascularization versus culprit-only PCI. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing complete revascularization to culprit-only PCI. RCTs were identified via a systematic search of MEDLINE, Embase, and Cochrane CENTRAL. Count data were pooled using DerSimonian and Laird random-effects models with inverse variance weighting to obtain relative risks (RRs) and 95% confidence intervals (CIs). A total of 9 RCTs (n = 6,751) were included, with mean/median follow-up times ranging from 6 to 36 months. Compared with culprit-only PCI, complete revascularization was associated with a substantial reduction in major adverse cardiovascular events (13.1% vs 22.1%; RR: 0.54; 95%CI: 0.43 to 0.66), repeat myocardial infarction (4.9% vs 6.8%; RR: 0.64; 95%CI: 0.48 to 0.84), and repeat revascularization (3.7% vs 12.3%; RR: 0.33; 95%CI: 0.25 to 0.44). Complete revascularization may have beneficial effects on all-cause and cardiovascular mortality, but 95%CIs were wide. Findings for stroke, major bleeding, and contrast-induced acute kidney injury were inconclusive. In conclusion, complete coronary artery revascularization appears to confer benefit over culprit-only PCI in patients with STEMI and multivessel CAD, and should be considered a first-line strategy in these patients. (C) 2020 The Author(s). Published by Elsevier Inc.
机译：大约一半的ST段抬高心肌梗死（STEMI）患者在直接经皮冠状动脉介入治疗（PCI）期间出现非梗死相关的多支冠状动脉疾病（CAD）。然而，关于STEMI和多血管CAD患者是否应常规进行完全血运重建仍存在疑问。我们的目的是比较ST段抬高型心肌梗死（STEMI）和多血管冠心病（CAD）患者随机完成血管重建与单纯PCI的主要心血管结局和程序并发症的风险。我们对随机对照试验（RCT）进行了系统回顾和荟萃分析，比较了完全血运重建和单纯PCI。通过系统搜索MEDLINE、Embase和Cochrane CENTRAL，确定了随机对照试验。计数数据使用DerSimonian和Laird随机效应模型与反向方差加权进行汇总，以获得相对风险（RRs）和95%置信区间（CI）。共纳入9项随机对照试验（n=6751），平均/中位随访时间为6至36个月。与仅限罪魁祸首的PCI相比，完全血运重建术可显著减少主要心血管不良事件（13.1%对22.1%；RR:0.54；95%CI:0.43至0.66）、重复心肌梗死（4.9%对6.8%；RR:0.64；95%CI:0.48至0.84）和重复血运重建（3.7%对12.3%；RR:0.33；95%CI:0.25至0.44）。完全血运重建可能对全因死亡率和心血管死亡率有有益影响，但95%的顺式反应是广泛的。中风、大出血和造影剂诱导的急性肾损伤的研究结果没有定论。总之，对于ST段抬高型心肌梗死和多支冠心病患者，完全冠状动脉血运重建术似乎比单纯的罪魁祸首PCI更有益处，应被视为这些患者的一线策略。（C） 2020作者。爱思唯尔公司出版。

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